What is the role of Dehydroepiandrosterone (DHEA) sulfate in women?

From the Guidelines

DHEA sulfate plays a crucial role in women's health, particularly in the treatment of vaginal dryness and pain with sexual activity, as evidenced by a randomized controlled trial of 464 survivors of breast or gynecologic cancer, which showed that vaginal DHEA led to significant improvements in sexual desire, arousal, pain, and overall sexual function 1. The use of DHEA sulfate in women is supported by recent studies, including a 2024 guideline that suggests vaginal androgens, such as DHEA, can be considered for vaginal dryness or pain with sexual activity 1. Key points to consider when using DHEA sulfate in women include:

• Vaginal DHEA can improve sexual function and reduce dyspareunia in postmenopausal women 1
• The safety of vaginal hormones, including DHEA, has not been firmly established in survivors of estrogen-dependent cancers, and therefore, should be used with caution in this population 1
• A thorough discussion outlining the uncertainty and potential risks and benefits should be had with the patient before initiating treatment with DHEA sulfate 1
• Other treatment options, such as vaginal estrogen, ospemifene, and flibanserin, may also be considered for the treatment of vaginal dryness and sexual dysfunction in women 1 In clinical practice, DHEA sulfate can be considered as a treatment option for women with vaginal dryness and pain with sexual activity, particularly in those who have not responded to other treatments, but its use should be carefully weighed against the potential risks and benefits, and patients should be closely monitored for any adverse effects 1.

From the Research

Role of Dehydroepiandrosterone (DHEA) Sulfate in Women

• DHEA and its metabolite, DHEAS, are the most abundant circulating steroid hormones, synthesized in the zona reticularis of the adrenal cortex, in the gonads, and in the brain 2.
• The precise physiological role of DHEA and DHEAS is not yet fully understood, but these steroid hormones can act as androgens, estrogens, and neurosteroids, and perform many roles in the human body 2.
• DHEA supplements have been found to alleviate vasomotor symptoms, preserve the integrity of the immune system, reduce bone loss, and increase muscle mass in postmenopausal women 2.
• Intravaginal DHEA has shown significant beneficial effects in menopausal women with severe vulvovaginal symptoms 2.

Therapeutic Effects of DHEA

• DHEA may slightly improve sexual function compared with placebo 3.
• DHEA is associated with androgenic side effects, mainly acne 3.
• There is uncertainty whether DHEA decreases menopausal symptoms 3.
• DHEA supplementation is effective in women with adrenal insufficiency, postmenopausal women with low bone mineral density and/or osteoporosis, premenopausal women with sexual disorders and low libido, and in women with vulvovaginal atrophy due to menopause or genitourinary syndrome of menopause 4.

Safety and Efficacy of DHEA

• The overall quality of the studies on DHEA is moderate to low, with the majority of studies having reasonable methodology 3.
• No serious adverse effects have been reported with DHEA supplementation 4.
• Further research is needed to better elucidate the efficacy and safety of DHEA supplementation for the treatment of androgen insufficiency in women 5.
• The use of DHEA is still controversial, especially regarding its effectiveness 4.